Healthcare Provider Details

I. General information

NPI: 1548581820
Provider Name (Legal Business Name): H N KUMARA, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PALO ALTO RD SUITE 133
SAN ANTONIO TX
78211-3758
US

IV. Provider business mailing address

102 PALO ALTO RD SUITE 133
SAN ANTONIO TX
78211-3758
US

V. Phone/Fax

Practice location:
  • Phone: 210-921-2011
  • Fax: 210-590-6997
Mailing address:
  • Phone: 210-921-2011
  • Fax: 210-590-6997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberE5397
License Number StateTX

VIII. Authorized Official

Name: DR. HALEKOTE N KUMARA
Title or Position: OWNER
Credential: MD
Phone: 210-921-2011